A Plea to Nurses Everywhere

A plea for nurses everywhere that arose after a drive home reflection. Conflict is as much a part of our work environment as medication administration. Does it really have to be? We can choose our attitudes and begin to treat our coworkers like we treat our patients. With respect.

I don't seem to process everything that I see, hear and do at work until I am home. My lack of reflection until later might have something to do with running around like a Looney Tunes character for eight or more hours caring for the sick. It is difficult to be reflective when life has to be lived so much in the moment.

But after the last IV has been hung, the last lab value dealt with, the last medication given and the last note written, as I drive home, fragments of my day begin to surface as I try to unwind.

I have different "topics", I guess you could call it, that I mull over as I drive depending on the week or the day.

Some days as I drive home I am reflecting on my assessment skills. Other days I am reflecting on my patient education skills. Sometimes I think about a new disease I learned about, or a new drug.

There is always room for improvement and I often wonder if I would go back and approach a certain situation differently.

I don't always reflect about nursing: there are some shifts where I drive home listening to the radio and trying NOT to think about anything that I did that day.

I have noticed lately, however, that a lot of my reflections on the drive home have to do with communication. Not nurse to patient communication, but staff communication.

Nurse to nurse communication.

Nurse to provider communication.

And quite often, what I am reflecting on is the negative communication that I see.

I know that this topic is not a new one. It has been discussed from many angles by many people more qualified than I. But I would like to show you, if I could, some things that I have seen in over a few weeks time. I imagine that you have seen similar situations.

I have seen and heard:

Staff nurses raising their voices (ok, screaming) at a charge nurse at the beginning of a shift because they didn't like their assignment (which, by the way, was not an unfair assignment). And no, I am not the charge nurse.

A student calling a health care provider, who spoke sharply at the student after a suggestion was made. The student was tearful as she got off the phone. When the healthcare provider came to the floor, she was incredulous that the student had been upset, because she thought she was just explaining to the student why she would not do what was suggested.

A nurse yelling at someone calling to give her report that "I will call you back when I am ready" and slamming the phone down.

Another nurse yelling at a pharmacy tech over the phone when an order wasn't right and again slamming the phone down.

A doctor trying to explain a unique diagnosis he felt a patient had to a nurse who then replied "So? Am I supposed to be impressed?"

Nurses rolling their eyes at dietary techs, housekeepers, etc. who didn't do something they needed help with the minute they needed it.

A doctor speaking curtly to a pharmacist about a lab value and then hanging up.

And I couldn't tell you about all of the little jabs that I have seen oncoming nurses give to off coming nurses during report. Quite often between 'older' nurses and 'younger' nurses over nitpicking things that don't amount to a hill of beans.

I understand that we work in stressful environments. We have to get things done. We can't always be worried about the other person being offended, and yes, some people are a little bit too sensitive.

But when this behavior is discussed, we seem to shrug our shoulders and say "Oh well, nurses eat their young. That is just the way it is. People shouldn't get offended so easily."
When I first graduated from nursing school and started in the workplace, I couldn't believe how vicious some nurses were to other nurses.

Trying to figure it out, I mentioned the phrase "Nurses eat their young" to my mother, who has no healthcare background at all. I had heard that phrase many times and it was just a matter of fact to me. "Well you know what they say, nurses eat their young" I mentioned to her offhandedly.

And she was shocked. I mean really shocked. As in stopped what she was doing shocked.
"What a horrible thing to say!" she said aghast. "That is just awful!"

She was incredulous that such a concept existed.

And so we should be.

I have whole chapters in some of my nursing books dedicated to conflict management. There are many great tips in those chapters. But isn't it sad that those chapters have to exist?

There is truth to horizontal violence in the workplace. But interestingly enough, I see a lot of lateral violence. Perhaps more that horizontal.

It's not just Doctors screaming at nurses I see. I see nurses screaming at Doctors. I see nurses screaming at nurses.

I see everything.

And usually I feel like just standing up and saying to my co-workers what my mother would say to me and my siblings when I was young: "Just be nice!"

I know that this topic has so much more involved than just 'being nice.' I know that sometimes, if you are too nice, you will get walked on and the job might not get done.
But theories and sayings like horizontal violence, nurses eating their young, stressful work environments aside, why can't we just be nice?

We DON'T have to disrespect other departments when they are giving us report. We DON'T have to get frustrated at the pharmacy tech because of a system error. We CAN check our tone of voice when we speak to other members of the team, including students.
We can THINK before we speak and we can CONTROL our emotions, and set the phone down gently.

We CAN respect a physician who wants to explain something interesting.

We CAN enjoy the challenge of a different assignment for the shift, and we DON'T have to yell to get what we want.

We are adults. And we are nurses. We need to care enough for the other person to check our stressed out, negative, horrible side at the door and care for those we work with as much as we care for our patients.

I am not telling you to be a doormat. When you need to stand up for yourself, stand up for yourself! But think before you act.

We should be just as shocked at the statement "Nurses eat their young" as my non-healthcare mother was.

Nurses don't just eat their young. They eat each other and everyone around them.

Let's stop.

Think about all of the conflict that you see on your next drive home like I have.
Are you part of it? Do you have to be?

How does it make you feel? Can you change?

Is there something that you need to do to change?

Maybe you are burned out.

I don't know. I just see the behavior.

But since I have not stood up on the desk at the nurses' station and shouted this as loud as I could, I will just say it here.

Enjoy this?

I am a RN. I enjoy my job. I actually really like it. Some days I want to scream, other days I want to laugh, every now and then I want to cry. I have to write for stress relief. Writing is better than a bunch of bad habits...http://sarahleeregisterednurse.wordpress.com/

From 'Anytown, USA'; 25 Years Old; Joined Jun '09; Posts: 82; Likes: 443.
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Why does burn out occur in the acute care setting?
Do all nurses in acute care suffer from burn out?
Is burn out more related to the nursing department, nursing or hospital management and treatment of staff than it is nurses?
How do you go about solving the problems that lead to burn out?
will putting a smile on our voice and face fix the problem or just pretty up the pig?

Seriously, I do think that as professionals we must conduct ourselves as such. However, many nurses (too many perhaps) work in very adversarial enviroments where they are not valued and not treated well...they are not super human, just people who want a fair shot.

OP I hear ya! People choose not to respect others and that is sad. Unfortunately, this kind of behavior will always exist because of the lack of accountability. Why change a behavior if no consequences are there?

I have NEVER been accused of being naive, or a pollyanna, but I really don't see this at work, at least not to the extent that many here do.

Of course, there are a select few - but a jerk is a jerk, and this is not a phenomenon that is limited to nursing. Or physician-ing...

This is primarily the reason that I resist my frequent urge to "fly the coop" and try out some of the "bigs" hospitals...

PS - Do you really have student nurses speak with doctors on the phone? I do not, for a couple of reasons - I like the students I work with... and the doctors too. It doesn't really seem fair to either. Besides - I wouldn't think a student could legally take a verbal/phone order...

I work in case management. Before that I was a Public Health Nurse working in a community clinic. In 6 years I've NEVER seen a shred of what you talk about. All the nurses I've worked with have been respectful, professional and like family to one another. ALL of them. Please don't blanket-statement all nurses like this, we don't all work in hospitals.

I understand AN is geared mostly toward acute care/floor/med Surg nursing, but a huge percentage of nurses work elsewhere, in environments other than hospitals. And that is where what you describe seems to happen most. It's important to point that out.

PS - Do you really have student nurses speak with doctors on the phone? I do not, for a couple of reasons - I like the students I work with... and the doctors too. It doesn't really seem fair to either. Besides - I wouldn't think a student could legally take a verbal/phone order...[/QUOTE]

Thanks for the input. If I have a student with me, no, I do not feel comfortable having them speak to the provider. But some nurses do encourage it. And so I have seen it done. Maybe they cosign the order with the student? I don't know because I personally don't do it...not because I don't trust the student-but like you I am not sure of the legalities behind it.

I work in case management. Before that I was a Public Health Nurse working in a community clinic. In 6 years I've NEVER seen a shred of what you talk about. All the nurses I've worked with have been respectful, professional and like family to one another. ALL of them. Please don't blanket-statement all nurses like this, we don't all work in hospitals.

I understand AN is geared mostly toward acute care/floor/med Surg nursing, but a huge percentage of nurses work elsewhere, in environments other than hospitals. And that is where what you describe seems to happen most. It's important to point that out.

Thank you for your perspective. I certainly do not intend to cover all nurses with this. In fact, sometimes it seems to be the minority of nurses that are like I described. But sadly I have seen a minority in this regard be the most vocal, and at times seem to have the most influence. Hence one of many reasons why hospital nursing is difficult for newer graduates-or any nurse for that matter..
But you are right. There are many, many, amazing respectful and professional nurses out there.
I have just been reflecting on my frustrations at a few of the negative ones. :P

Staff nurses raising their voices (ok, screaming) at a charge nurse at the beginning of a shift because they didn’t like their assignment (which, by the way, was not an unfair assignment). And no, I am not the charge nurse.

A student calling a health care provider, who spoke sharply at the student after a suggestion was made. The student was tearful as she got off the phone. When the healthcare provider came to the floor, she was incredulous that the student had been upset, because she thought she was just explaining to the student why she would not do what was suggested.

A nurse yelling at someone calling to give her report that “I will call you back when I am ready” and slamming the phone down.

Another nurse yelling at a pharmacy tech over the phone when an order wasn’t right and again slamming the phone down.

A doctor trying to explain a unique diagnosis he felt a patient had to a nurse who then replied “So? Am I supposed to be impressed?”

Nurses rolling their eyes at dietary techs, housekeepers, etc. who didn’t do something they needed help with the minute they needed it.

A doctor speaking curtly to a pharmacist about a lab value and then hanging up.

*** WOW! I am _SO_ glad I dont' work where you work! You MUST know that you work in a defective work enviroment and that your faciliety and similar are exceptions to the rule? Your unit or hospital culture is broken. Is this a Magnet hospital? Sounds like it.

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*** WOW! I am _SO_ glad I dont' work where you work! You MUST know that you work in a defective work enviroment and that your faciliety and similar are exceptions to the rule? Your unit or hospital culture is broken. Is this a Magnet hospital? Sounds like it.

I know after my article you might find this hard to believe but where I work is actually a very good place to work as a general rule. I do have to use some creative license for the sake of privacy. This post is actually not truly reflective of my work environment as a whole. There are nurses that I work with that are amazing and professional to all they come in contact with. But there are some nurses-spread across different shifts and departments who seem to be content to be totally miserable. Who would truly believe that this post was dead on accurate as to the negativity that they see around them simply because they seem to want to be bitter. And I think that is sad. These are just my observations of a few situations that I have observed over a period of time....and work environments. There are always some 'bad apples' in any barrel..the same holds for any work environment I am sure. The post is not meant to be indicative of where I work in general but of some attitudes that I have seen over the years rolled into a few more recent observations. I believe that violence in the workplace does happen-and this is my way of bringing attention to it.
Sometimes all it takes is one rude comment to make a new or seasoned nurse feel like he or she is working in the worst place in the world when really (myself included) if we all could be a little nicer maybe it wouldn't seem so bad.

To the nurses that scream at me that they wont take report....we have ways to fix that. Next time I guarantee you will be nicer and state a reason you cant take report as opposed to just yelling at me.